Your browser doesn't support javascript.
loading
Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing.
Jasaui, Yamile; Mortazhejri, Sameh; Dowling, Shawn; Duquette, D'Arcy; L'Heureux, Geralyn; Linklater, Stefanie; Mrklas, Kelly J; Wilkinson, Gloria; Beesoon, Sanjay; Patey, Andrea M; Ruzycki, Shannon M; Grimshaw, Jeremy M.
Afiliação
  • Jasaui Y; Continuing Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • Mortazhejri S; Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Dowling S; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
  • Duquette D; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
  • L'Heureux G; Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada.
  • Linklater S; Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada.
  • Mrklas KJ; Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Wilkinson G; Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Edmonton, AB, Canada.
  • Beesoon S; Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada.
  • Patey AM; Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
  • Ruzycki SM; Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Grimshaw JM; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. shannon.ruzycki@ucalgary.ca.
Perioper Med (Lond) ; 12(1): 3, 2023 Mar 02.
Article em En | MEDLINE | ID: mdl-36864470
BACKGROUND: Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery ('low-value preoperative testing') among anesthesiologists, internal medicine specialists, nurses, and surgeons. METHODS: Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. RESULTS: Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). CONCLUSIONS: We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels.
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Idioma: En Revista: Perioper Med (Lond) Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Idioma: En Revista: Perioper Med (Lond) Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá